by Tom aka Rusty Rustbelt
Health Care Thoughts: Conference Wrap-up
So I do some conferences with a lot of people who are way smarter than me, people literally and figuratively on the cutting edge.
What thoughts are dominating health care these days, especially the provider community? Here is a list of frequent talking points, further in-depth discussion of some of them later.
The provider community is in chaos, seeking “what is the best strategic move to insure survival?”
The focus of Obamacare isn’t clear, is it?
- quality is paramount
- cost reduction is paramount
- both are paramount
- nobody knows
- something will evolve
Integration is the biggest trend now, pushed by Obamacare
The feds (CMS, DOJ, FTC) are inconsistent about integration
Integration is pulling power and resources into hospitals and big systems
Hospitals are complex, badly managed“germ boxes” (hospital executives disagree of course)
Hospitals will continue overcharging insured patients until a better solution is found for uninsured and under-insured patients, hospital billing chargemasters are incoherent to all but the creators
Hospitals hate transparency
Hospitals have very powerful lobbies and will block anything that moves revenue out of their building
Integration is the enemy of innovation / integration is a necessary first step
Hospitals are buying physician practices and employing physicians at a rapid pace – just like the 90s some of this will eventually unravel
“Big Pharma,” “ Big Devices”and “Big I.T.” have too much lobbying power and are too dominant (personal observation – why the orthopedic device companies have not been sued for price fixing is beyond me, possibly because they negotiate enough high volume discount deals to look legit although they are not) – in a world where many prices are coming down these prices continue to rise
So far, “Big I.T.” is the top winner from Obamacare
Employer health premiums 1) are skyrocketing, employers are re-contracting with higher deductibles and higher co-pays or 2) insurers are keeping premiums level but contracting higher copays and deductibles as the standard plan – eventually this will dramatically change the insurance market, the health care market and possibly the employment markets, or 3) some combination
ANSWER to specific question from Terry– yes a portion of cost reduction is deferred care due to higher copays and deductibles plus generally weak incomes – wide spread agreement among providers on this issue – percentage nationwide? Hard to estimate
Health care is very regional and very geographical – hard to nail down exact trends
Rural health care is screwed (not enough density) unless rural providers can integrate with urban providers in a mutually beneficial manner
EMR and ICD-10 rollouts have the potential for disaster
Medicaid expansion is a good thing, but not salvation
Primary care is holding up so far, but there are risks around every corner
Dentists and veterinarians are the happiest providers these days
Insurers and employer groups are shopping to buy providers – take out the middle man approach (several health insurers are already invested in primary care networks) – could be good or bad
The last half of this year and 2014 are going to be really interesting.
Tom aka Rusty Rustbelt